As a parent, it can feel like a lot changes when your child turns 13 — who knew your mere existence could suddenly be so embarrassing for them? Another big shift: Your teenager may start making some medical decisions on their own and won’t always need your consent, which can come as a surprise to some folks.
But don’t worry — we’re here with our experts to break things down and give you a clearer picture of what to expect, from the services that minors can access without your permission to services that will still require your consent or at least your notification.
Why Washington law protects your teen’s medical privacy
In Washington state, when a child turns 13, their parents no longer have access to certain parts of their medical records — which can be an adjustment for families who are used to easily accessing that information.
The state’s laws on minors and healthcare access ensure that certain sensitive information stays confidential between teens and their healthcare team and won’t be automatically shared with their parents.
Why does this happen? The primary reason is to protect children and ensure they get the care they need no matter their family situation, according to Dr. Julian Davies, a pediatrician at the Pediatric Care Center at UW Medical Center – Roosevelt and a UW School of Medicine clinical professor of general pediatrics.
“The laws recognize a right to privacy and autonomy around mental and reproductive health for teens, and we want to follow the law and provide the best care for our patients,” says Davies. “Studies show that sexually active teens are a lot more likely to use birth control and get tested for STIs when parental notification is not required.”
He goes on to explain that teens also feel more comfortable talking about their mental health and/or substance use when they can speak confidentially.
These privacy laws kick in at 13 because kids are going through many changes at that age — both physically and mentally. In response, doctors incorporate more information about topics like sexual health, substance use, gender identity and mental health into teens’ wellness visits. Davies recognizes that it can be challenging for some parents to be asked to head to the waiting room while their teen has confidential conversations with their doctor. But understanding how these rules work can help make the situation a bit easier for everyone involved.
Services teens can access without your consent
In Washington, minors can make decisions about (and get services for) a variety of things for which they don’t need your consent. Here are some major ones:
At age 13 minors can make their own decisions about inpatient and outpatient mental health services. They can also seek either outpatient or inpatient substance abuse services. In some cases, they may also be able to get consultations related to gender identity without an authorized adult’s consent.
At age 14 minors can make decisions about receiving sexually transmitted disease tests and treatment.
At any age minors can get birth control, have access to abortion-related services or receive prenatal care.
Certain services, like gender-affirming medical treatments such as puberty blockers and hormone therapy, still generally require parental consent for patients under the age of 18 in Washington.
What happens to your teen’s online medical information
What about digital access to your teen’s medical history? Most healthcare providers offer access to an online patient portal, like MyChart, where you can view your and your child’s health records. When your kid turns 13, however, your ability to view those medical records will change. Parents and legal guardians of minors will have “proxy access” to their kid's account, which means you will still be able to do things like:
- Message their care team
- View, schedule or cancel upcoming appointments
- Refill the medications that the team has made visible to you
- View their immunization records (except for HPV vaccine shots)
- View preventive care reminders
- View and update insurance information
On the other hand, proxy access won’t allow you to view healthcare information (labs, tests, medications, clinician notes) related to the kinds of care that Washington allows teens to access without parental consent, including:
- Reproductive and sexual healthcare
- Mental health care
- Substance use care
Parents can still request copies of notes and labs via MyChart messaging, and clinicians will determine what they can share or if they need to redact sensitive information. This can be especially helpful for parents of teens with complex health needs.
Lenny Sanchez, director of Patient Information Privacy/HIPAA at UW Medicine, says every healthcare organization deals with parental access in a slightly different manner based on the organization’s risk tolerance. UW Medicine protects the confidentiality of teens around sensitive issues like reproductive choice and freedom, while providing their legal guardians with limited access to their medical records on MyChart.
“Not all teen patients have healthy or safe family situations, so we have to keep that in mind,” says Sanchez.
Instances that “bend” the access rules
There are a few exceptional situations for which the rules are different for parents accessing teens’ medical records. They include when:
A teen is cognitively disabled. Davies explains that there is a process to allow caregivers of cognitively disabled adolescents to have full access to medical records — but only when there are significant impairments that preclude the adolescent from making independent mental health or reproductive health decisions.
A teen is emancipated. Children who are emancipated, or free from parental or legal guardian control, are in full control of their medical records from the time of emancipation.
A teen is married to an adult. According to the law, teens who are married to a legal adult can get healthcare services without an authorized adult’s consent.
A teen is a mature minor. This is determined by their doctor and allows teens full control of their healthcare decision (without parental consent needed).
A learning experience for teens ... and parents
It’s understandable that parents are anxious about the changes that suddenly happen in the healthcare system when their kids turn 13. Here are some ways to prepare yourself and even try to make the best of an uncomfortable situation.
Turn this into a learning experience for your teen
Yes, it’s scary, but you can encourage them to embrace this first taste of independence and the opportunity to make their own decisions.
"It’s great for teens to develop a more independent relationship with their care team as they approach adulthood,” says Davies.
After all, they will soon be responsible for all aspects of their health.
Partner with their pediatrician during the transition process
Some ways to do this? Ask questions.
“There are a few questions that you should ask your pediatrician before the ‘big day,'" says Davies. These include:
- How will adolescent visits work at the clinic? (For example, at Davies’s clinic, doctors usually start the visit with the teen and parent together and then spend some confidential time with just the teen at the end of the visit.)
- What is the best way to use MyChart during my child’s teenage years?
- What are situations where a provider cannot keep adolescent information confidential? (For example, if there’s reason to believe a teen is being abused, neglected or is otherwise in danger.)
Support their relationship with their doctor, therapist or other trusted adult
Having another adult in your teen’s life that they trust and can talk to is beneficial — because they may not always want to talk to you about every topic. Encourage them to ask their doctor questions and discuss things that might be uncomfortable to talk to a parent about. That means that when the going gets tough, they’ll feel like there’s another person that they can reach out to if they need to.
Understand that your teen can still share their private conversations with you afterwards
There’s no reason why your teen can’t still talk to you about the uncomfortable stuff if they wish to — so it’s OK to ask them if they have any questions after their appointment or if they want to discuss anything with you.
Remember that your child’s care team is dedicated to keeping them safe
Your teen’s care providers are obligated to break confidentiality if your teen discloses a high risk of significant harm to themselves or others — which should be reassuring to guardians. And, as Davies explains, those important limitations on confidentiality are shared with the teens at the outset of private conversations.
Balancing the needs of both parents and teens can be a complicated endeavor when it comes to healthcare and medical records, but your pediatrician wants to keep you in the picture.
"We welcome parents to share their concerns directly with us, even if our replies are constrained by confidentiality,” says Davies. “We prefer shared decision-making with teens and their parents around mental and reproductive health when possible and safe.“